Neuroimaging studies linked to neurological developmental challenges of extremely preterm infants: Faculty Scholar leads multicenter NEURO study

Neonatologist Susan Hintz, MD, MS Epi, has worked closely with research teams and families over the last decade on investigating neuroimaging and neurodevelopmental outcomes of extremely preterm infants. She was funded as the Arline and Peter Harman Faculty Scholar (2009-2015) and received $500,000 from the Stanford Child Health Research Institute to support the research. (Photo credit: Erin Lubin)

Tuesday, September 25, 2018

Neonatologist Susan Hintz, MD, MS Epi, has spent the better part of the last decade investigating what neonatal neuroimaging findings may be able to predict about neurological developmental challenges at early school age among children born extremely preterm. This ambitious, prospective research was supported by the Stanford Child Health Research Institute (CHRI), which awarded Dr. Hintz with $500,000 in funding as the Arline and Peter Harman Faculty Scholar (2009-2015).

Results from the Neuroimaging and Neurodevelopmental Outcomes (NEURO) School Age Follow-Up Study were recently published in Pediatrics. Dr. Hintz is the lead author on the paper summarizing the findings, and neonatologist Krisa Van Meurs, MD, also a CHRI member, is a co-author.

The NEURO study evaluated a series of neonatal neuroimaging findings from cranial ultrasounds (CUS) and brain magnetic resonance imaging (MRI) to determine whether those findings could predict cognitive development difficulties and disabilities at two years of age, and later at six to seven years. Cranial ultrasound (CUS) is the routine neuroimaging tool for preterm infants, but brain magnetic resonance imaging (MRI) may be more sensitive to certain types and locations of injury. Controversies and questions remain as to which neuroimaging studies should be performed, when to perform them, and their relative values in prognosis.

“Without the support of the CHRI and the Arline and Pete Harman Faculty Scholar Fund, I would have been unable to lead this very time-intensive and challenging multicenter study on neuroimaging and neurodevelopmental outcomes of extremely preterm infants,” says Dr. Hintz, who is the Robert L. Hess Family Professor in the Division of Neonatal and Developmental Medicine. “The Harman Faculty Scholarship supported my time and effort, which was essential to successful execution and completion of the study.”

The NEURO study shows that adverse findings from neuroimaging studies are linked to severe cognitive impairment and disability among early school-aged children who are born extremely preterm. While findings underscore the impact of severe neonatal brain injuries, Dr. Hintz says “it also adds to our understanding of prognostic uncertainty for preterm infants even in the setting of serial brain imaging.” She says neonatologists should be aware of the complexities of outcomes and limitations of prediction from neuroimaging at an individual level.

The NEURO study also received funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Heart, Lung, and Blood Institute (NHLBI). The study involved 15 different sites across the United States that are part of the NICHD Neonatal Research Network, and it required support from a variety of specialists at each site. Significant resources were needed because the study tracked children far past the 2-year time point that is typical of typical follow-up studies on extremely preterm infants.

Beyond the NEURO study’s primary research objective, the work has provided researchers with a rich data set that adds to our knowledge in other areas. “With the enormous amount of information that we have on these children at school-age from NEURO study visits, we will be able to report findings on numerous outcomes that would be of great interest to families and to providers,” says Dr. Hintz.

Indeed, the data offers other opportunities for understanding preterm children, including behavioral challenges, academic successes and difficulties, health impacts, and the quality of life for both child and family. Two other analyses from the NEURO study were recently published and identified rates of overweight and obesity, and hypertension at early school age in the same cohort of children born extremely preterm. Findings showed that one in five children were overweight or obese and had central obesity at early school age, and one in ten children had systolic hypertension. Dr. Hintz is senior author on both papers.

“I feel truly fortunate to have had the opportunity to develop and lead this very large, multicenter study. More importantly, I feel privileged to have had the chance to work so closely for so long with the many dedicated teams and families who were involved were this study,” says Dr. Hintz. “None of this would have been possible without the support of the CHRI and the Harman Faculty Scholarship.”

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